Student Background Information – Part II ……………….. Page 9

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Student Essay – Part III ………………………………… Page 11

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income families in Fairfax, Loudoun and Prince
William Counties, who demonstrate academic
excellence and would otherwise not have an
opportunity to go to college

Scholarship monies to be determined after fund-raising activities.

PLEASE DIRECT ANY QUESTIONS TO YOUR SCHOOL COUNSELING OFFICE.

Washington Dulles International Airport Rotary ClubHistory and BackgroundThe club was formed during the period of July 1979 through February 1980. On the night of February 23 1980 the club charter was signed at Rotary International in Chicago. This coincided with the 75th Anniversary of the founding of Rotary. The club celebrated its 32nd anniversary on the 23rd of February 2012.Since its inception, the club and its members have been involved in both local and international charitable activities. The members participate in international activities through the Rotary Foundation. Locally the club has supported needy organizations through our Annual Golf Tournament Fundraiser, Christmas Bell Ringing for the Salivation Army, and the support of local charities on a case-by-case basis.ServiceInternational Service

Polio Plus program has virtually eradicated polio from the globe. Over 2 billion people have bee immunized.

Ambassadorial Scholarships Program is the largest privately funded source of international scholarships with approximately 1,300 scholarships awarded annually.

Group Studies Exchange: 568 Teams traveled to different countries in 1999-2000 with 8,000 total teams since 1965.

Deadline for this scholarship is April 3, 2013. All information is to be turned into the Career Center of the School Counseling office.

Selection Criteria:

Demonstrated financial need. This is the Rotary’s most important criteria.

Demonstrated strong background in community service & helping others.

Demonstrated 3.0 Grade Point average or better.

Merits of the college program or curriculum sought.

Demonstrated ability and a sincere interest in the pursuing college degree.

Recommendations of teachers and guidance counselors.

Additional Information:

The Rotary plans to give two (2) - four (4) scholarships with the amount to be determined after fundraising events are finalized.

Applicants should show interest in community service and possible interest in Rotary.

Finalist will be asked to attend an interview for the selection committee to make their final recommendations.

Winners are expected to attend Rotary meetings to inform membership on their progress.

Winners will be expected to assist with scholarship fund-raiser.

It is the hope of the Dulles International Airport Rotary to entice students to learn about Rotary and Service Above Self. We know that getting financing for four years is always a challenge…especially in these times.

BY THE APPROVAL OF THE BOARD OF DIRECTORS OF THE DULLES INTERNATIONAL AIRPORT ROTARY, THE SELECTION COMMITTEE WILL BE THE SOLE GOVERNING BODY AWARDING THE SCHOLARSHIP ON BEHALF OF THE BOARD OF DIRECTORS OF THE DULLES INTERNATIONAL AIRPORT ROTARY, ITS MEMBERSHIP, AND ITS SPONSORSPlease Do Not Return This Sheet with Application

DID I PROVIDE INFORMATION THAT SUBSTANTIATES MY ACCOMPLISHMENTS, GRADE POINT AVERAGE WITH COPY OF TRANSCRIPT FROM MY HIGH SCHOOL?

DID I PROVIDE REQUIRED FINANCIAL STATEMENT TO VALIDATE FINANCIAL NEED?

DID I FILL OUT NEATLY OR TYPE ALL INFORMATION AS THOROUGHLY AS POSSIBLE?

HAVE I ATTACHED THREE LETTERS OF RECOMMENDATION FROM SCHOOL COUNSELORS AND TEACHERS WHO CAN EXPOUND ON ME AND MY ACCOMPLISHMENTS?

DID I COMPLETE ALL SECTIONS OF THE FORMS PROVIDED?

(IMPORTANT PAGES THAT MUST BE RETURNED 7, 8, 9, 10, 11, 12, 13)
APPLICANT TO KEEP THIS PAGE

Guidelines for Teacher’s Recommendation LetterAttention Teachers:

In order for the student to qualify your letter must be received in our offices on or before April 3, 2013.

How long have you known the applicant?

Describe the growth and development of the student?

How diversified is the student within the school activities?

How is the student’s overall academic performance?

How well does the student adapt to the other members of the class, school, etc.?

How has the student participated within the community where he/she resides?

What future course or plan of study has been discussed with the student?

What guidance have you provided?

Why would you want this scholarship to be awarded to this student?

IMPORTANT CRITERA

Please provide verification that the student grade overall point average is a 3.0 or better

Please provide verification that financial assistant is mandatory for the student to go to college (additional financial statement documentation will be provided for required completion)

Student Please Note: Applicants are to provide above guidelines to Instructor(s)/Teacher(s), who will be providing recommendation(s).

ATTENTION TEACHERS:

Since we receive applications from only local students, we may receive applications from more than one of your students. Please help us in our decision-making by ensuring your letter of recommendation is unique to the student.

Student Application - Part I

Type or Print Neatly in Black Ink

Please fill in as completely as possible.

NAME OF CANDIDATE: Last First M.I.

HOME ADDRESS:

_______________
Town/City State Zip Code

HOME TELEPHONE NO.:

NAME OF HIGH SCHOOL:

PRESENT GRADE LEVEL*:

DATE OF BIRTH:

* Student must be a graduating senior in 2013

The decision to apply for the Dulles International Airport Rotary Scholarship Program is my own, and I will abide by the regulations explained in the Program Requirements and Criteria for Selecting Candidates. The responses contained in the student application form are my own.

Date Signature of Candidate

To be completed by Parent or Guardian

Parent or Guardian:
With whom does the student reside: _________ Parent __________ Guardian
FULL NAME OF PARENT/GUARDIAN:

ADDRESS:

TELEPHONE NO.:I, the parent/guardian of _____________________________________, permit him/her to be considered as a scholarship candidate for the Dulles International Airport Rotary Scholarship Program. I understand that if he/she is selected to receive the scholarship, the monies must be used for the completion of the College program or curriculum noted on the application. Further, I understand that the grant does not imply any additional financial support, and if accepted, my child will be responsible for the remainder of costs, if any.

Date Signature of Parent/Guardian

Financial Statement Form – Part I

I. Student Employment (Includes full or part-time during the last two years):

*List of other scholarship applications that have submitted and list organizations. List any scholarships received to date.

Student Background Information – Part II

**Please complete in blue or black ink or type. Additional pages may be attached. A transcript is available from your guidance office and must be attached to this application.

Accepted by (colleges or universities)

(To be verified in by counselor with attached transcript):

Class Rank GPA

Scholastic Honors

Student Background Information – Part II

Use ONLY the space provided and the back side of this sheet if necessary.

Extra-curricular Activities (include number of years and offices held)

Community Activities (include number of years and offices held)

Student Essay – Part IIIUse ONLY the space provided and the back side of this sheet if necessary.

Please describe your family life and background as well as why you need and will

benefit from this scholarship.

Student Essay – Part IIIPlease reply to the following questions in essay form. Use ONLY the space provided and the back side of this sheet if necessary.Please write an essay discussing how you live your life that would exemplify the 4 Way Test of Rotary

The Rotarian’s 4-WAY TEST

Of the things we think, say, or do

Is it the TRUTH? . . . . . .

Is it FAIR to all concerned?

Will it build GOODWILL And better FRIENDSHIPS?

Will it be BENEFICAL to All concerned? . . . . . . .

Student Essay – Part III

Please reply to the following questions in essay form. Use ONLY the space provided and the back side of this sheet if necessary.